HomeMy WebLinkAboutBLD2023-01203 - BLD CD Environmental Health Review - 10/9/2023 I t
DocuSign Envelope ID:7ED20898-820D-4148-AF4F-8A0D2BDDC81CF.' . .
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MASON COUNTY Permit No:��d-va3-01d�3
COMMUNITY DEVELOPMENT OCTn ft
1-. •t` Permit Assistance Center, Building,Planning OC i I1 5 2023 M
>. BUILDING PERMIT APPLICATION 615 W. Alder Stree C
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: S O
NAME:JAMES&PATRICIA JEVEC NAME:SOUTH SHORE CONSTRUCTION INC _ Z
! MAILING ADDRESS:4202 JESSICA LN MAILING ADDRESS:PO BOX 963
CITY: CARROLLTON STATE:TX _ZIP:75010 CITY:BELFAIR STATE:WA ZIP:98528 r` n.
PHONE#1:469-348-4052 PHONE: 360-801-4432 CELL: 360.801-4432 —4
311,
PHONE#2: EMAIL:southshore@q.com = RI
EMAIL:mandm76@aol.com L&I REG#SOUTHSC016NL EXP.02 /10 /2024 2
PRIMARY CONTACT: OWNER❑ CONTRACTOR 2/ OTHER❑
NAME TONI SHEEHY-SOUTH SI±QRE CONSTRUCTION INC EMAIL SOUTHSHORE(rD_Q.COM
MAILING ADDRESS PO BOX 963 CITY BELFAIR STATE WA Zip 98528 -,rtJr
PHONE 360-801-4432 CELL 360-801-4432 NG,c1
PARCEL INFORMATION: OCT 0 9 2023 __
PARCEL NUMBER(12 Digit Number) 12118-50-00034 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) MOUNTAIN SHORES TR 34&1/80 INT TR 41 S 52/225,S 53/42 FIRE DISTRICT 3 RECEIVED
SITE ADDRESS 40 E MOUNTAIN PL CITY GRAPEVIEW ,,
DIRECTIONS TO SITE ADDRESS East on W Alder St,at traffic circle,take 1st exit onto N 1st St.Turn left onto E Pine St,cont onto WA-3 N.right onto
E Grapeview Loop Rd.,cont.straight to stay on E Grapeview Loop Rd,right onto E Rauschert Rd,right onto Mountain Dr,right onto Mountain PI,lot is straight ahead.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO Q' SNOW LOAD: 25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW® ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.)RESIDENTIAL
IS USE: PRIMARY g SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)If YES(Part[s]of Bldg)❑ NO❑
DESCRIBE WORK INSTALL NEW MH FOR RESIDENTIAL USE
SOUARE FOOTAGE:(proposed)
1ST FLOOR 1920 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft COVERED DECK sq.ft. STORAGE sq.ft OTHER sq.ft
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE KIT HOMES MODEL GRAND MANOR 6003 YEAR 2023 LENGTH 48'
WIDTH 40. BEDROOMS 3 BATHS 2 SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 2
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
� uSigrowl try- COUNTY CODE 14.08.42)
X p,.....e 2.4.... 9/27/2023
"` gna`)ure of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL Q�I��
PUBLIC HEALTH t t I 1 LGt� l�l "'�'$ CN
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